CASE STUDY R03

Reconstruction with MENTOR® MemoryShape® Breast Implants after

Circumvertical Mastectomy Courtesy of Mark Brzezienski, MD

Chattanooga, TN

Patient Profile

The patient has mid-range C breasts with some ptosis. The nipple is at the inframammary crease and the areolar complex is about 8 cm wide. She is deeply tanned, and notes that swimwear is an important part of her lifestyle. She has been happy with her breasts and has not considered aesthetic breast surgery.

Physical Exam

• 55-year-old female• Height: 5’-8”• Weight: 166 lbs.• Bilateral breast reconstruction• Does not want to maintain the nipple areolar complex

Desires to maintain breast size but appear

“lifted”

Pre-op

The circumvertical mastectomy (CVM) technique is inspired by cosmetic breast surgery incisions. In cosmetic breast surgery, incisions are confined to the infra-mammary crease or a straight vertical direction to the inferior areolar complex. The CVM confines the scar to the central inferior pole of the breast. The surgical excision is actively shortened to as close to 10cm as possible with progressive tension and imbricating technique. With a 10cm scar length, the neo-NAC can reliably consume the superior 5cm. This gives the illusion that the mastectomy scar is just about 5cm long. In our practice, tissue expander exchange to permanent implant is always performed through the inframammary crease incision (a well-accepted cosmetic surgery access point).

Circumvertical Mastectomy (CVM)

On the day of surgery, patient was marked by her plastic surgeon for a circumvertical mastectomy. After mastectomy, 550cc CPX™4 Breast Tissue Expanders were placed. Progressive tension closure of the pockets were performed. The lengths of the closures were imbricated to 10cm. Over the following three weeks, she was successfully expanded to 600cc. Her mastectomy weights were L 654g and R 660g. Approximately three months after mastectomy and expander placement, patient returned to the OR where she underwent an exchange to form stable implants. MENTOR® MemoryShape® Breast Implants Style MM (Medium Height, Moderate Projection) with a volume of 640cc were placed using inframammary crease incisions. No fat injection grafting was performed. One month after this intervention, nipples were reconstructed using a modified Kroll technique. Three months after her nipple reconstruction, she underwent three dimensional tattooing.

Implant & Placement

Post-op ( 8 months ) Right: 640cc Style MM MemoryShape®

Implant

Left: 640cc Style MM MemoryShape®

Implant

The CVM can be employed in patients even with significant ptosis. At the tissue expander exchange in these patients, excess skin in the horizontal axis can be easily excised to maximize cosmesis. We believe that the CVM produces improved superior fullness that is unaffected by any scarification. It also leaves no scar in the “top-down” look, which is the patient’s perspective. Our breast surgeons are very comfortable with this type of mastectomy and feel that they can reliably and easily perform a thorough oncologic procedure through its incisional footprint.

Important Safety Information

For detailed indications, contraindications, warnings, and precautions associated with the use of all MENTOR® Implantable Devices, which include MENTOR® Saline-filled Breast Implants, MemoryGel® Breast Implants, MemoryShape™ Breast Implants, and CPX® Breast Tissue Expanders, please refer to the Product Insert Data Sheet provided with each product or visit www.mentorwwllc.com.

Mentor Worldwide LLC© Mentor Worldwide LLC 2016 061112-161004

MENTOR® MemoryShape® Breast Implants are indicated for breast augmentation in women at least 22 years old, or for breast reconstruction. Breast implant surgery should not be performed in women with active infection anywhere in their body, with existing cancer or pre-cancer of their breast who have not received adequate treatment for those conditions, or who are pregnant or nursing.

Breast implants are not lifetime devices and breast implantation may not be a one-time surgery. The most common complications with MENTOR® MemoryShape® Breast Implants for breast augmentation include reoperation for any reason, implant removal with or without replacement, and ptosis. The most common complications with MENTOR® MemoryShape® Breast Implants for breast reconstruction include reoperation for any reason, implant removal with or without replacement, and capsular contracture. A lower risk of complication is rupture. The health consequences of a ruptured silicone gel breast implant have not been fully established. MRI screenings are recommended three years after initial implant surgery and then every two years after to detect silent rupture.

Patients should receive a copy of Patient Educational Brochure – Breast Augmentation with MENTOR® MemoryShape® Breast Implants or Patient Educational Brochure – Breast Reconstruction with MENTOR® MemoryShape® Breast Implants, and a copy of Quick Facts about Breast Augmentation & Reconstruction with MENTOR® MemoryShape® Breast Implants. Your patient needs to read and understand the information regarding the risks and benefits of breast implants, with an opportunity to consult with you prior to deciding on surgery.